慢性肾脏病患者外周血T淋巴细胞亚群的变化与分析

Altered peripheral blood T-lymphocyte subsets in patients with chronic kidney disease

目的：了解研究各期慢性肾脏病（CKD）患者外周血T淋巴细胞亚群的变化规律,探讨T细胞功能紊乱相关的免疫调节治疗理论依据.方法：2009年5月至2010年3月广州医学院第三附属医院CKD患者180例,按2002年美国K/DOQI标准将患者分为CKD1～4期4个组和CKD5期血液透析组、CKD5期非透析组,共6组,每组30例.另取30例健康人作为对照组.对测定的各组患者外周血CD3＋细胞、CD3＋CD4＋细胞、CD3＋CD8＋细胞、血肌酐、血尿素氮等指标进行比较分析.结果：CKD1期患者CD3＋、CD3＋CD8＋细胞比对照组显著升高（P=0.000）.与CKD1期患者比较,CKD 2、3期患者CD3＋、CD3＋CD4＋细胞比例明显降低（P=0.000）.与CKD 2、3期患者比较,CKD4期和CKD5期非透析组患者CD3＋、CD3＋CD4＋细胞降低（P=0.000）.CKD 5期血液透析组患者与非透析患者比较,CD3＋CD8＋细胞升高（P=0.440）.结论：慢性肾脏病患者存在T细胞免疫功能异常,早期出现T淋巴细胞亚群失调,随着肾小球滤过率的下降,细胞免疫功能进一步下降.血液透析治疗未显示能有效改善患者T淋巴细胞亚群紊乱.

Objective：To explore the altered peripheral blood T-lymphocyte subsets in patients with various stages of chronic kidney disease, and to provide evidence that underlines immunoloregulation for T-lymphocyte subsets functional disorder. Methods： 180 patients registered to the Third Affiliated Hospital of Guangzhou Medical College during May 2009 and March 2010 were selected in the study. According to US K/DOQI, these patients were divided into CKD1 ,CKD 2,CKD 3 and CKD 4 groups,as well as CKD 5 haemodialysis group and CKD 5 non-haemodialysis group （ n = 30 each）. In addition,30 healthy adults were selected for controls. We measured and compared the data on peripheral blood CD3＋ , CD3＋CD4＋ , and CD3＋CD8＋ subsets, serum creatinine and blood urea nitrogen among these groups. Results： CKD 1 group showed increased counts of CD3＋and CD3＋CD8＋ as compared with controls （ P = 0.000 ）. The differential counts of CD3＋ and CD3＋ CD4＋ in CKD 2 and CKD 3 groups were significantly lower than those in CKD 1 group （ P = 0.000）. Compared with CKD 2 and CKD 3 groups, patients in CKD 4 and CKD 5 non- haemodialysis groups showed decrease in CD3 ＋ and CD3= CD8 =（ P = 0. 000 ）. Compared with CKD 5 non-hemodialysis group, CKD 5 hemodialysis group had increased CD3= CD8= cells （ P = 0. 440）. Conclusion： Chronic renal disease patients may have T-cellular immune dysfunction which is reflected by imbalance of T-lymphocyte subsets in the early stage and deteriorated cell immune function as glomerular filtration rate decreases. Haemodialysis was not shown to improve T- lymphocyte subsets dysfunction.